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Whipple's Triad

Definition:

Whipple's Triad is a diagnostic criterion for insulinoma, consisting of three key features:


The Three Components of Whipple's Triad

1. Symptoms known or likely to be caused by hypoglycemia: Neuroglycopenic symptoms (e.g., confusion, dizziness, seizures) and adrenergic symptoms (e.g., sweating, tremors, anxiety).
2. Low blood glucose levels: Measured plasma glucose ≤ 55 mg/dL (≤ 3.1 mmol/L).
3. Relief of symptoms with glucose administration: Resolution of symptoms after glucose intake.


Diagnostic Criteria

Whipple's Triad is considered positive if all three criteria are met:


1. Symptoms consistent with hypoglycemia.
2. Documented low blood glucose.
3. Symptomatic relief with glucose.


Clinical Significance

Whipple's Triad:

1. Confirms insulin-mediated hypoglycemia.
2. Supports diagnosis of insulinoma.
3. Differentiates insulinoma from other causes of hypoglycemia.


Limitations

1. Not all insulinoma patients present with Whipple's Triad.
2. Other conditions (e.g., factitious hypoglycemia) may mimic Whipple's Triad.


Diagnostic Tests

To confirm insulinoma:

1. Fasting glucose test.
2. Insulin levels.
3. C-peptide levels.
4. Glucose tolerance test.
5. Imaging studies (CT, MRI, PET, ultrasound).


Treatment

1. Surgical resection of insulinoma.
2. Medical management (diazoxide, octreotide, glucagon).


Prognosis

Excellent prognosis with prompt diagnosis and treatment.


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